VA Experience with Implementing Intensive Primary Care Programs for Veterans at Highest Risk
Intensive primary care (IPC) programs for high-need, high-risk patients have become increasingly championed by expert panels and policymakers as a way to improve access and quality while more wisely using healthcare resources. While IPC programs are popular, the elements critical to their success are poorly understood. In designing their own IPC program, VA leaders sought to identify approaches that would: 1) decrease VA emergency department visits and hospital use among Veterans at the highest risk of hospitalization; 2) increase high-risk Veterans' satisfaction with VA care; 3) reduce primary care provider frustration and burnout; and 4) be cost-neutral or cost-saving. In 2014, VA implemented five distinct intensive primary care programs – called PACT Intensive Management – as part of a demonstration project that targeted Veterans at highest risk of hospitalization. This case study describes VA's experience with implementing these programs, as well as the program elements that appear to be necessary to meet the complex care needs of these high-risk Veterans.
SUMMARY OF FINDINGS:
The PACT Intensive Management program (PIM) has been successfully implemented for more than three years at five demonstration sites in the VA healthcare system. The PIM program has evolved over time, eventually converging on implementation of the following elements:
- An interdisciplinary care team,
- Chronic disease management,
- Comprehensive patient assessment and evaluation,
- Care and case management,
- Transitional care support,
- Preventive home visits,
- Pharmaceutical services,
- Chronic disease self-management,
- Caregiver support services,
- Health coaching, and
- Advanced care planning.
PIM teams also found that including social workers and mental health providers on the interdisciplinary teams was critical to effectively address the psychosocial needs of these complex patients. In addition, having a central implementation coordinator facilitated the convergence of these program features across diverse demonstration sites.
In future iterations of these programs, VA intends to standardize staffing and key features to develop a scalable program that can be disseminated throughout the system.
Drs. Chang, Raja, and Stockdale are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) in Los Angeles, CA.
Chang E, Raja P, Stockdale S, et al. on behalf of the PIM Executive Committee, National Evaluation Committee, and Demonstration Sites. What are the Key Elements for Implementing Intensive Primary Care? A Multisite Veterans Health Administration Case Study. Healthcare. October 25, 2017; Epub ahead of print.